Urban Built Environments and Trajectories of Disability Among Older Adults

描述（由申请人提供）：老年人特别依赖当地社区，由于健康和功能状况下降，经济紧张和社会孤立，容易受到城市建筑环境中的障碍（例如交通繁忙，不安全的人行道和缺乏行人便利设施）。然而，建筑环境对老年人独立性的影响还没有得到充分的研究。本研究的目的是了解建筑环境在残疾进展中的作用。具体而言，该项目的目标有三个方面：1）详细描述社区居住老年人高风险人群周围的建筑环境; 2）检查建筑环境与残疾进展之间的关系; 3）确定居住在交通不便的社区的老年人是否更有可能随着时间的推移被送进养老院。研究目标将通过二级数据分析程序与现有的人口为基础的数据（密歇根州最小数据集家庭护理）使用定量多层次方法和地理信息系统（CIS）软件的组合进行调查。潜在的轨迹类分析将被用来检查的影响，城市可达性和城市设计的轨迹移动残疾和随后的疗养院入院超过15个月的时间。将获得在本研究中适当使用GIS和空间分析技术所需的技能，作为职业发展计划的关键组成部分。候选人将利用密歇根大学和其他地方的广泛资源和培训机会，获得必要的技能，从事研究职业，适当地将以人为本的变量置于人们年龄增长的更大社会和环境背景下。目前对晚年健康和独立性的研究几乎只强调个人层面的因素。然而，周围环境的作用可能在塑造老年人的独立和依赖模式方面发挥关键作用。该项目致力于实现疾病预防控制中心的健康保护目标之一，即“健康场所中的健康人”，其重点是设计建筑环境，为有残疾风险的老年人定义健康社区。

DESCRIPTION (provided by applicant): Older adults are particularly dependent on their local communities, and due to declining health and functional status, financial strain and social isolation, are vulnerable to barriers in the urban built environment (e.g. heavy traffic, unsafe sidewalks, and a lack of pedestrian amenities). Yet the effect of the built environment on independence in older adults is under-studied. The purpose of this research is to understand the role of the built environment in disability progression. Specifically, the aims of this project are threefold: 1) to characterize in detail the surrounding built environment for a high risk population of community-dwelling older adults; 2) to examine the relationship between the built environment and disability progression; and 3) to identify whether older adults living in less accessible neighborhoods are more likely to be admitted to a nursing home over time. The research objectives will be investigated through a program of secondary data analysis with existing population-based data (Michigan Minimum Data Set for Home Care) using a combination of quantitative multilevel methods and geographic information systems (CIS) software. Latent trajectory class analysis will be used to examine the effect of urban accessibility and urban design on trajectories of mobility disability and subsequent nursing home admission over a 15 month period. The skills needed to appropriately use GIS and spatial analysis techniques for this research will be obtained as a key component of the career development plan. The candidate will draw on a broad range of resources and training opportunities throughout the University of Michigan and elsewhere, to obtain the necessary skills to pursue a research career that appropriately situates person-centered variables within the larger social and environmental context in which people age. Current research on later life health and independence places almost exclusive emphasis on factors at the individual level. Yet, the role of the surrounding environment may play a key role in shaping patterns of independence and dependence among older adults. This project addresses one of CDC's Health Protection Goals, "Healthy People in Healthy Places", by focusing on the design of built environments that define healthy communities for older adults at risk for disability.